Director, Clinical Health Services

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Company: AETNA
Location: New Albany, OH 43054

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Description:

Office Based Position: New Albany, OH – 7400 West Campus Road

Oversees the implementation and on-going execution of the strategic and operational business plan for the business segment’s clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinates business segment policies and procedures in support of financial, operational and service requirements.
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Fundamental Components:

Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction. Serve as liaison with regulatory and accrediting agencies and other health business units. Formulate and implement strategy for achieving applicable department/unit metrics and provide operational direction. Serve as technical, professional and business resource (may cross multiple business functions). Develop and participate in presentations and consultations to existing and prospective customers. Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions). Participates in internal and external health industry development efforts. Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions) Implements and monitors business plan and oversees any implementations or business transitions impacting service operations. Collaborates and partners with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis. Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions.

Background Experience:

5 years clinical leadership within a managed care organization, including concurrent review, prior authorization and management of remote team required
3 years Medicare advantage experience preferred
Healthcare Management preferred
Medicaid experience preferred
Ability to synthesize program performance and clinical outcomes required
Lean Six Sigma preferred
RN Required in Ohio


Required Skills:

Leadership – Collaborating for Results, Leadership – Driving a Culture of Compliance, Leadership – Engaging and Developing People

Education:

Nursing – Registered Nurse

Potential Telework Position:

No

Percent of Travel Required:

10 – 25%

EEO Statement:

Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:

Aetna takes our candidate’s data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.